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NPI Code Detail

MEDICARE: MICHAEL DENNIS BUSSOLINI P.T.

MEDICARE: MICHAEL DENNIS BUSSOLINI P.T.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical TherapistPT 9092CA

General Provider Information

NPI Number : 1245325125
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAEL DENNIS BUSSOLINI P.T.
Provider Business Mailing Address
First Line : 1893 MONTEREY HWY
Second Line : SUITE200
City : SAN JOSE
State : CA
Zip : 95112-6136
Country : US
Telephone Number : 408-288-3815
Fax Number :
Provider Business Practice Location Address
First Line : 1893 MONTEREY HWY
Second Line : SUITE200
City : SAN JOSE
State : CA
Zip : 95112-6136
Country : US
Telephone Number : 408-288-3815
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/04/2006
Last Update Date : 07/08/2007

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